The Preoperative Neutrophil-To-Lymphocyte Ratio Is a Novel Immune Parameter for the Prognosis of Esophageal Basaloid Squamous Cell Carcinoma

<div><p>Background</p><p>The pretreatment neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of prognosis in various malignancies, but its predictive capacity in basaloid squamous cell carcinoma of the esophagus (BSCCE) remains unclear. We aim to determine the value of the inflammation-related factors, including the NLR, neutrophil-to-monocyte ratio (NMR), and albumin levels, in predicting BSCCE prognosis.</p><p>Methods</p><p>We retrospectively analyzed the records of 121 patients with pathologically diagnosed BSCCE that underwent a curative esophagectomy from January 2007 to December 2014. Univariate and multivariate analyses were used to identify prognostic factors for overall survival (OS) and recurrence-free survival (RFS).</p><p>Results</p><p>The preoperative NLR was correlated with the tumor length and NMR. In OS univariate analyses, a high NLR (>1.77), high NMR (>12.31), and low albumin (≤40.0 g/L) level were significantly associated with a poorer survival in BSCCE. The median OS was significantly greater in low NLR (≤1.77) than in the high NLR (>1.77) patients (51.0 vs. 31.0 months; P = 0.008). In multivariate analyses, only the NLR was an independent prognostic factor for OS (hazard ratio (HR), 2.030; 95% confidence interval (CI), 1.262–3.264; P = 0.003). A high NLR was also an independent predictor of a poorer RFS in BSCCE (HR, 2.222; 95% CI, 1.407–3.508; P = 0.001); the median RFS for low (≤1.77) and high (> 1.77) NLR patients was 44.0 months and 14.0 months, respectively. NLR remained a strong prognostic indicator for OS in stage I/II patients and a preoperative NLR>1.77 was predictive of a poor RFS in both stage I/II and stage III patients.</p><p>Conclusions</p><p>We show that the preoperative NLR, a convenient and cost-effective biomarker, may serve as a prognostic indicator for BSCCE patients following curative surgery.</p></div

Correlation between clinicopathological characteristics and the neutrophil-to-lymphocyte ratio in basaloid squamous cell carcinoma of the esophagus

<p>Correlation between clinicopathological characteristics and the neutrophil-to-lymphocyte ratio in basaloid squamous cell carcinoma of the esophagus</p

Typical microscopic features of basaloid squamous cell carcinoma of the esophagus (BSCCE).

<p>(A,B,&C) The typical features were a nesting, lobular, or trabecular arrangement of basaloid cells with comedo-type necrotic foci and small cystic spaces in the tumor center. Immunohistochemical staining using p63 (D), pan-cytokeratin(E), and Ki-67 (F) antibodies was positive.</p

Univariate analysis of prognostic factors for overall survival and recurrence-free survival in 121 patients with basaloid squamous cell carcinoma of the esophagus

<p>Univariate analysis of prognostic factors for overall survival and recurrence-free survival in 121 patients with basaloid squamous cell carcinoma of the esophagus</p

Further stratified analysis of NLR for overall survival (OS) and recurrence-free survival (RFS) in patients with different stages.

<p>(A) In stage I/II patients, the median OS in the low NLR (≤1.77; n = 40) group was 144.0 months, which was significantly longer than the 38.0 months observed in the high NLR (>1.77; n = 36) group. (B) The median RFS of the low NLR (≤1.77; n = 40) group was 105.0 months, which was longer than the 26.0 months observed in the high NLR (>1.77; n = 36) group. (C) In stage III patients, the median OS in the low NLR (≤1.77; n = 23) group was 33.5 months, which is numerically but not significantly longer than the 15.0 months observed in the high NLR (>1.77; n = 22) group.(D) The median RFS in the low NLR (≤1.77; n = 23) group was 27.0 months, which is significantly longer than the 6.0 months observed in the high NLR (>1.77; n = 22) group.</p

Univariate analysis of overall survival (OS) and recurrence-free survival (RFS).

<p>(A) The median OS of the low neutrophil–to–lymphocyte ratio (NLR; ≤1.77) group was 51.0 months, which was significantly longer than the 31.0 months observed in the high NLR (>1.77) group. (B) A significant difference in median OS was also observed between the low (≤12.31) neutrophil–to–monocyte ratio (NMR) group and high (>12.31) NMR group (43.0 vs. 31.0 months). (C) The median OS of the low (≤40.0 g/L) albumin groupwas 26.0 months, which was shorter than the 42.0 months observed in the high (>40.0 g/L) albumin group. (D) The median recurrence-free survival (RFS) was 44.0 months for the low (≤1.77) NLR group and 14.0 months for the high (> 1.77) NLR group. The median RFS in patients with a high NMR or albumin level was numerically, but not significantly, greater than patients with a low NMR (E) or albumin level (F).</p

Cox proportional hazards model of prognostic factors for overall survival and recurrence-free survival in 121 patients with basaloid squamous cell carcinoma of the esophagus

<p>Cox proportional hazards model of prognostic factors for overall survival and recurrence-free survival in 121 patients with basaloid squamous cell carcinoma of the esophagus</p